Wound Repair and Regeneration最新文献

This meta-analysis aimed to systematically assess and synthesise healing rates within a 12- to 24-week treatment period among patients with diabetic foot ulcers receiving standard-of-care interventions in randomised controlled trials. This meta-analysis included 32 randomised controlled trials conducted between 1996 and 2023, with sample sizes ranging from 9 to 169 patients. A random-effects model was applied to estimate pooled healing and infection rates. Heterogeneity was quantified using the I² statistic, and publication bias was assessed using Egger's test. The results revealed a pooled healing rate of 33.15% with a 95% confidence interval (CI) of 31.18%-35.11% and an average healing time of approximately 50.14 days (standard deviation: 31.10 days). The infection proportion was determined to be 17.4% (95% CI: 12.2%-22.5%). Subgroup analysis indicated marginally higher healing rates in the 'Saline Gauze' group compared to the 'Alginate' group, although the latter exhibited a reduced infection proportion. Sensitivity analysis affirmed the robustness of these findings whereas Egger's test suggested the presence of potential publication bias concerning the healing outcomes. The standard-of-care interventions for diabetic foot ulcers demonstrate limited effectiveness, with only about one-third of patients achieving wound closure. The significant heterogeneity and publication bias observed necessitate a cautious interpretation of these results. The findings highlight the need for advanced wound care strategies and personalised treatment plans to improve outcomes in diabetic foot ulcers management. Future research should focus on conducting high-quality, well-reported randomised controlled trials to better understand effective treatments for DFUs.

Full-thickness burn wounds pose significant problems, demanding specialised therapies to avoid complications and promote recovery. Eschar tissue, which forms in response to severe burns, contains viable fibroblasts, which migrate from the surrounding tissue in response to burn injury and exhibit a myofibroblast phenotype. The goal of this study was to characterise eschar-derived fibroblasts and examine their use for engineered in vitro full skin equivalents in comparison to normal dermal fibroblasts, which were harvested from non-injured skin. Microarray analysis indicated that eschar fibroblasts differ from dermal fibroblasts in various biological processes including inflammation, extracellular matrix formation, cell migration and differentiation. Skin equivalents with eschar fibroblasts showed similarities to those generated using normal dermal fibroblasts in terms of epidermis and dermis formation. However, in contrast to dermal fibroblast-based full skin equivalents, eschar fibroblast-based equivalents exhibited macroscopic contractile behaviour. In addition, eschar fibroblasts-based equivalents demonstrated higher alpha-smooth muscle actin expression on mRNA and protein levels. In conclusion, our findings suggest that eschar fibroblasts-based full skin equivalents hold promise as a platform to study burn wound environments as eschar fibroblasts are clinically more relevant fibroblasts and able to mimic certain aspects of the challenging wound environment in vitro.

The WOUND-Q is a patient-reported outcome measure for individuals with any type of chronic wound. This study aimed to identify patient and wound factors associated with the four WOUND-Q health-related quality of life (HRQL) scales: Life impact, Psychological, Sleep, and Social. Adults with a chronic wound were recruited internationally through clinical settings between August 2018 and May 2020, and through an online platform (i.e. Prolific) in September 2022. Multivariable linear regression analyses were conducted to identify factors significantly associated with the WOUND-Q scales. The assessments obtained were 1273, 1275, 706, and 1256 for the Life Impact, Psychological, Sleep, and Social scales, respectively. The mean age of participants was 55 (SD = 18) years; most (66%) had a single wound, and most (56%) wounds had lasted more than 6 months. The most common causes were trauma, surgery, and diabetic foot ulcer. Wound characteristics associated with worse scores on at least one of the scales were drainage, vacuum treatment, aetiologies (i.e. diabetic foot ulcer, trauma, other, multiple), duration (i.e. 10-11 months), having four or more wounds, smell, and sleep interference, while wound location different from the face or neck was associated with better scores (p < 0.05). Patient factors associated with worse scores included having diabetes or a comorbidity, whereas increasing age or male gender were associated with better scores (p < 0.05). Sleep disturbances had the largest negative influence on HRQL scores. This study identified factors affecting HRQL in individuals with chronic wounds. Understanding these associations can inform better management and treatment strategies to improve HRQL for these patients.

Traditional wound dressings, despite their widespread use, face limitations, such as poor infection control and insufficient healing promotion. To address these challenges, bioactive materials have emerged as a promising solution in wound care. This comprehensive review explores the latest developments in wound healing technologies, starting with an overview of the importance of effective wound management, emphasising the need for advanced bioactive wound dressings. The review further explores various bioactive materials, defining their characteristics. It covers a wide range of natural and synthetic biopolymers used to develop bioactive wound dressings. Next, the paper discusses the incorporation of bioactive agents into wound dressings, including antimicrobial and anti-inflammatory agents, alongside regenerative components like growth factors, platelet-rich plasma, platelet-rich fibrin and stem cells. The review also covers fabrication techniques for bioactive wound dressings, highlighting techniques like electrospinning, which facilitated the production of nanofibre-based dressings with controlled porosity, the sol-gel method for developing bioactive glass-based dressings, and 3D bioprinting for customised, patient-specific dressings. The review concludes by addressing the challenges and future perspectives in bioactive wound dressing development. It includes regulatory considerations, clinical efficacy, patient care protocol integration and wound healing progress monitoring. Furthermore, the review considers emerging trends such as smart materials, sensors and personalised medicine approaches, offering insights into the future direction of bioactive wound dressing research.

Bacterial biofilms represent a formidable challenge in the treatment of chronic wounds, largely because of their resistance to conventional antibiotics. The emergence of multidrug-resistant (MDR) bacterial strains exacerbates this issue, necessitating a shift towards exploring alternative therapeutic approaches. In response to this urgent need, there has been a surge in research efforts aimed at identifying effective non-antibiotic treatments. Recently noted among the non-antibiotic options are selective serotonin reuptake inhibitors (SSRIs) and beta-adrenergic (β-AR) antagonists. Both have demonstrated antimicrobial activities and wound-healing properties, which makes them particularly promising potential therapeutics for chronic wounds. This review seeks to comprehensively evaluate the landscape of non-antibiotic strategies for managing wound infections. By analysing the latest research findings and clinical developments, it aims to shed light on emerging therapeutic alternatives. Additionally, the review delves into the potential of repurposing systemic therapeutics for topical application, offering insights into the feasibility and challenges associated with current approaches. We also address the necessity of translating promising preclinical results into tangible clinical benefits.

Pressure injuries in critically ill patients present a significant healthcare burden. Traditional methods, such as the Braden score, assess the risk of developing pressure injuries by evaluating factors like sensory perception, moisture and mobility. In contrast, thermographic imaging, which measures variations in skin temperature, offers a promising tool for not only assessing risk but also enabling earlier identification of pressure injuries. This study assessed thermographic imaging's ability to detect existing and evolving pressure injuries in surgical intensive care unit (SICU) patients and compared its accuracy with the Braden score. Among 465 patients, 76 underwent thermographic evaluations of the sacrum and/or heel. Of 25 patients with pressure injuries at admission, 23 had abnormal thermographic scores. Fifteen patient developed pressure injuries during SICU admission. Logistic regression showed that abnormal thermographic scores significantly increased the likelihood of detecting both existing and new injuries, while the Braden score was not a significant predictor. Thermographic imaging appears to be a superior predictor of pressure injuries, offering earlier detection and potentially improving patient outcomes while reducing healthcare costs.

New analgesics are needed for painful wounds. Multiple reports suggest that topical sevoflurane may have analgesic effects. This placebo-controlled randomised trial evaluated the analgesic efficacy and safety of VPX638 (topical sevoflurane). Seventy-eight participants with painful wounds, were enrolled at eight Australian centres and randomly allocated to receive 2 × 5 mL of VPX638 (N = 39) or placebo (N = 40) during one wound dressing change. Numerical pain rating scores and use of opioids were recorded for 24 h. The primary endpoint was pain during wound cleaning, secondary endpoints evaluated pain for 24 h after drug application and opioids use. There was no significant difference in mean pain scores during wound cleaning between VPX638 and placebo (0.854; p = 0.23). The mean differences in summed pain intensity difference from baseline suggested VPX638 provided greater analgesia compared to placebo over 8 h (p < 0.02), 12 h (p < 0.01) and 24 h (p < 0.05) and significantly longer duration of analgesia, 24.3 h for VPX638 versus 7.1 h for placebo (p < 0.01). In the 24 h after drug administration, participants receiving VPX638 had a 50% decrease in opioid use over 24 h compared with placebo. VPX638 appeared safe and well-tolerated. In conclusion, this small placebo-controlled randomised trial suggested that VPX638 provides analgesia and is opioid-sparing for up to 24 h after wound cleaning. It supports the need for further evaluation of the benefit of VPX638 as a topical analgesic for painful wounds.

Bacterial colonisation in hypertrophic scars (HSs) has been reported, yet the precise mechanism of their contribution to scar formation remains elusive. To address this, we examined HS and normal skin (NS) tissues through Gram staining and immunofluorescence. We co-cultured fibroblasts with heat-inactivated Staphylococcus aureus (S. aureus) and evaluated their levels of apoptosis and proliferation by flow cytometry and Cell Counting Kit-8 assay, respectively. Additionally, we performed proteomic analysis and western blotting to identify upregulated proteins. To assess autophagy levels, we examined light chain 3 (LC3) expression through western blotting and immunofluorescence, and transmission electron microscopy (TEM) was performed to detect autophagy-associated vesicles. Our results demonstrated a notable increase in bacterial load, primarily S. aureus, in HS tissues. Furthermore, S. aureus promoted fibroblast proliferation and enhanced the expression of profibrotic markers such as transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF), collagen I, collagen III and α smooth muscle actin (α-SMA). Proteomic analysis highlighted heat shock factor-binding protein 1 (HSBP1) as a key upregulated protein mediating the profibrotic effects induced by S. aureus. Knockdown of HSBP1 reversed these effects. Intriguingly, HSBP1 also upregulated LC3 and Beclin-1 expression and increased the number of autophagosomes in fibroblasts. Finally, when fibroblasts stimulated by S. aureus were treated with HSBP1 siRNA, autophagy levels decreased significantly. Collectively, our findings suggest that S. aureus, via HSBP1, stimulates fibroblast proliferation and promotes their transition into myofibroblasts, triggering autophagy and fibrosis. These results underscore the potential of HSBP1 as a therapeutic target for the management of HSs.

The objective of this systematic review was to synthesise the evidence of the impact of pressure injuries (PIs) on the health-related quality of life (HRQoL) of adults aged 18 years and older. Electronic databases (Ovid Medline, Ovid Embase, CINAHL EBSCO, Scopus and Central Register of Controlled Trials) were searched for eligible studies published between January 2019 and April 2024. All identified articles were reviewed by two reviewers against the eligibility criteria. The risk of bias was assessed using the Mixed Methods Appraisal Tool and the Joanna Briggs Institute critical appraisal tool. Data were narratively synthesised due to methodological heterogeneity. Twenty-two studies (12 quantitative; 9 qualitative;1 mixed methods) met the inclusion criteria. The qualitative studies were grouped into four impact areas: symptoms, physical function, psychological well-being and social functioning. Five instruments were used to assess HRQoL and identified low scores in people with PIs, with the lowest scores mostly reported in physical functioning and role physical and emotional concepts. A complexity of factors influenced theHRQoL of people with PI. This review synthesised both quantitative and qualitative evidence indicating PI was associated with low HRQoL scores and negatively affected all aspects of HRQoL. This review emphasised the complexity of factors related to PI and its impact on HRQoL. Further emphasis on the impact of the complexity of factors on HRQoL of people with PI should be considered in future studies.

Preclinical studies for wound healing disorders are an essential step in translating discoveries into therapies. Also, they are an integral component of initial safety screening and gaining mechanistic insights using an in vivo approach. Given the complexity of the wound healing process, existing guidelines for animal testing do not capture key information due to the inevitable variability in experimental design. Variations in study interpretation are increased by complexities associated with wound aetiology, wounding procedure, multiple treatment conditions, wound assessment, and analysis, as well as lack of acknowledgement of limitation of the model used. Yet, no standards exist to guide reporting crucial experimental information required to interpret results in translational studies of wound healing. Consistency in reporting allows transparency, comparative, and meta-analysis studies and avoids repetition and redundancy. Therefore, there is a critical and unmet need to standardise reporting for preclinical wound studies. To aid in reporting experimental conditions, The Wound Reporting in Animal and Human Preclinical Studies (WRAHPS) Guidelines have now been created by the authors working with the Wound Care Collaborative Community (WCCC) GAPS group to provide a checklist and reporting template for the most frequently used preclinical models in support of development for human clinical trials for wound healing disorders. It is anticipated that the WRAHPS Guidelines will standardise comprehensive methods for reporting in scientific manuscripts and the wound healing field overall. This article is not intended to address regulatory requirements but is intended to provide general guidelines on important scientific considerations for such studies.